Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

Hanna T, Bajorek B, LeMay K, Armour CL. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management. Pharmacy Practice 2014 Jan-Mar;12(1):390. Original Research Using scenarios to test the appropriateness of pharmacist prescribing in asthma management Tamer HANNA, Beata BAJOREK, Kate LEMAY, Carol L. ARMOUR. Received (first version): 15-Nov-2013 * ABSTRACT Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenariobased questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results: In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. Keywords: Asthma; Drug Prescriptions; Community Pharmacy Services; Professional Practice; Professional Role; Patient Simulation ; Australia INTRODUCTION Asthma rates in Australia are comparatively high internationally1, and asthma control amongst these 2,3 In addition to patients is generally inadequate. * Tamer HANNA. B.Pharm(Hons). The University of Sydney. Sydney, NSW (Australia). Beata BAJOREK. B.Pharm(Hons), Dip.Hosp.Pharm, GradCertEdStud (HigherEd), PhD. Associate Professor. University of Technology Sydney. Sydney, NSW (Australia). Kate LEMAY. B.Pharm, M.A. Project Manager. Woolcock Institute of Medical Research, The University of Sydney. Sydney, NSW (Australia). Carol L. ARMOUR. B.Pharm(Hons), PhD. Professor of Pharmacology, Director. Woolcock Institute of Medical Research, The University of Sydney. Sydney, NSW (Australia). Accepted: 8-Mar-2014 clinical consequences, asthma poses a great economic load on the Australian health sector and individual patient.1,4 This prevalence and morbidity of asthma in Australia have led to a focus on its treatment, however the standard of current practice 5,6 is less than ideal. Given the focus on a more multidisciplinary model of primary care, the utilisation of the pharmacist’s skills may help. Asthma management programs using specially trained pharmacists have been developed and proven to be successful in terms of clinical, economic and humanistic outcomes.7-9 However, there is scope for pharmacists to do more. Pharmacists in other countries, such as the UK, USA and Canada, have adopted expanded 10-14 Broadly, prescribing roles into their practice. these models of prescribing are either independent or dependent (i.e. collaborative with another prescriber) in nature.15 Supplementary prescribing, a form of dependent prescribing, is the most utilised and preferred approach, where a pharmacist can develop, in consultation with another prescriber, a patient-specific clinical management plan under 10 In Australia, which he/she can prescribe. momentum for the structured and rational implementation of pharmacist prescribing has developed through initiatives such as the “Health Professionals Prescribing Project”16 and Prescribing Competencies Framework17 with input from the Pharmacist Prescribing Collaborative of Australia and New Zealand (PPCANZ). Australian pharmacists already ‘prescribe’ over-the-counter “Pharmacy/Pharmacist Only” medicines, and with a framework of prescribing already in place, pharmacist prescribing in Australia can very much 18 complement the scope of practice. Literature on pharmacist prescribing in Australia in primary health care is limited, but evolving. To date, much of the Australian research has focused on exploring the practice landscape to ascertain its readiness for pharmacist prescribing, including: exploring views of pharmacists19-22, general 23 15 practitioners , and clients ; identifying needs and preferences for training and skill development24; surveying pharmacists’ experiences of training opportunities25,26; and developing frameworks for 27 the implementation of pharmacist prescribing. Some pilot studies have explored the implementation of pharmacist prescribing in hospital practice, with a particular focus on anticoagulation 28,29 A or specific settings (e.g. preadmission clinics). more recent study conducted in the preadmission clinic of a tertiary hospital has shown that pharmacist-prescribed inpatient medication charts can improve medication safety (i.e. fewer significant www.pharmacypractice.org (ISSN: 1886-3655) 1 Hanna T, Bajorek B, LeMay K, Armour CL. Using scenarios to test the appropriateness of pharmacist prescribing in asthma management. Pharmacy Practice 2014 Jan-Mar;12(1):390. omissions of medicines, less prescribing errors) and maintain optimal prophylactic therapy (i.e. prevention of venous thromboembolism).30 Whilst the hospital setting provides encouraging findings, particularly in providing data that may translate into improved outcomes and supporting the role of the pharmacist in this setting, additional research is needed to determine the potential for pharmacist prescribing in Australian community pharmacies, with a particular focus on high priority disease states such as asthma. Asthma also falls within a limited range of indications that pharmacists have identified as being suitable for independent prescribing, despite the general preference of 31 pharmacists for supplementary prescribing , highlighting their level of confidence in this area. Targeting chronic diseases, such as asthma, is underpinned by the Health Reform agenda, where 31 the National Primary Health Strategy emphasises ‘Better management of chronic conditions’ as one of its priority directions for change, and (...truncated)